Shunts and Surgery

Well Kali and I made our trip to Nashville AGAIN. For someone who didn't drive for 4 months I have made up in driving lately. Not that this was a goal of mine. Kali had a ultrasound on her head. Her doctor has decided that we shouldn't wait any longer  she needs a shunt.

Kali will be going in December 18th at 7:30am for her surgery, in Nashville. The procedure is about 35-45 minutes and she will stay overnight and then most likely be ready to go home on Wednesday. 

If you would like to join with us we will be fasting for Kali on Sunday. 

Below is a bit more about a shunt, what it does and why she needs one. 

What is a shunt?

A shunt is a straw like device that is placed beneath the scalp and inserted into the brain to relieve pressure in the brain. Kali, like many kids with the myelomeningocele form of spina bifida has hydrocephalus (sometime referred to as "water on the brain," although this term is not accurate). Hydrocephalus develops as cerebro-spinal fluid is unable to properly circulate from the ventricles inside the brain up and down the spinal cord and around the outside of the brain. As a result, the cerebro-spinal fluid builds up in the ventricles, placing pressure on the brain. Shunts are designed to relieve the pressure.

To my understanding, the shunt has three parts: the portion that is inserted into the ventricles, a valve, and a catheter.The piece that extends into the brain in infants is inserted between sections of the skull. The valve is attached to the former piece and is outside the skull. The catheter attaches to the other side of the valve and runs under the skin to the abdomen. The catheter empties into the abdomen through a small incision. 

The valve in the shunt opens when the pressure in the ventricles increases to a certain point and bleeds off cerebro-spinal fluid into the catheter (and consequently into the abdomen) until the pressure is reduced to a point where the valve closes. The cerebro-spinal fluid is reabsorbed by the body from the abdomen.

Shunts have a limited lifespan. According to the Spina Bifida Association of America, "[a]bout 40% of shunts will malfunction and need to be changed (or revised) within 1 year of insertion, 60% will require a revision within 5 years, and 80-85% within 10 years. About 20% will require multiple revisions in their lifetime." Typically, only the top portions of the shunt need to be replaced.

Why Did Kali Need A Shunt?

Approximately 80% of children with a myelomeningocele require a shunt. Her ventricles increases about 5mm in the last 3 weeks. She has been steadily increasing since she was born. Her head circumference has also increased, while we love a growing head we don't like when they jump growth lines and are almost off the chart. Her soft spot is also a little tighter.